Dr. Debra Bercovici’s journey shows the importance of resilience and self-discovery. As a Professor at the University of Toronto, she brings an impressive academic background but beyond her academic pursuits, Dr. Bercovici is a registered psychotherapist, blending scientific expertise with therapeutic practice. Diagnosed with autism at 28, Dr. Bercovici’s lived experiences deeply inform her work and advocacy, shedding light on the intersection of autism and ADHD (AuDHD) while championing inclusivity and neurodiversity in academia and beyond.
“AuDHD” is a term that’s been gaining more visibility recently. How does the intersection of autism and ADHD impact an individual’s experience and support for someone who identifies as AuDHD?
Dr. Bercovici: I think I can start first with the history of the term because one reason you’ve never heard of it is because it technically isn’t an official term. In research, “AuDHD” is not used a lot, especially in STEM and neuroscience fields. We always talk about autism and ADHD. When someone is diagnosed even if they have both conditions, their diagnosis is not “AuDHD.” It’s autism and ADHD. They are still two separate things. It’s more like a colloquial term that the community may use.
To answer your question, I think one hard thing to talk about is that there isn’t a lot of research on it. Most of the research only studies autistic people or only studies individuals with ADHD. It’s very rare but it is becoming more popular now. But it is rare to see studies that recognize both together and look at that experience as something separate from just being diagnosed with one or the other. That is really important because the experience is different. One of the biggest ways it is different is autistic traits and ADHD traits can contradict each other. For example, when I talk to people with AuDHD or based on my own experiences, I see that someone may need routine and needs everything to be organized but they just can’t. That routine just does not happen. I can be so disorganized. It’s a lot of those contradictions that create a lot of distress.
In the research, we see that AuDHD people often have more mental health issues and may have more support needs because of these competing characteristics. You can also imagine that a lot of these traits can make things feel really intense. You can imagine that some of these characteristics are also additive and so if someone has a sensory sensitivity, it can be so much more intense if you are also the type of person that can’t focus. Sometimes the distress comes from contradictory characteristics and the chaos associated with that as well as the characteristics become additive and that also can create chaos. Even though AuDHD isn’t as highly recognized yet in research and clinical settings, we do know that this is a very common neurodivergent experience. Estimates show that upwards of 60% of autistic individuals also have ADHD!
Gabi: I never thought about it that way. I knew that there is diagnosis overlap but I have never considered the behaviors as contradictory. I feel like the two conditions are always so paired together that you never see that they don’t really go together. Adding on to that, what’s your opinion on misdiagnosis? A lot of people who are diagnosed with ASD sometimes are first diagnosed with ADHD and I think that’s very common.
Dr. Bercovici: I have a lot of opinions on misdiagnoses in general. I can share a little about that. Despite being a neuroscientist, I’m not really into the whole label thing. I very much see neurodivergence as an identity the same way that you can think of any other identity. I think diagnoses are helpful to understand yourself and give you a way to find more community if that’s something you want, as well as allow you to seek support that is more targeted to your needs. That’s what I see diagnoses as.
With that being said, in theory, it doesn’t really matter if you have one or the other. I just consider it as an aspect of identity. But where it becomes an issue is if you can only get support for one of those things. People will get an ADHD diagnosis and they’ll go on stimulants. Some things may get better but overall, they don’t get enough support, or it may not be the right support for their unique experience. That’s when I think misdiagnoses really can affect people. When you are not able to understand yourself and aren’t able to access the support you may need.
Gabi: I like what you said about labels. One huge thing I’ve learned about is the broader autism phenotype and how I exhibit characteristics that could classify as autistic, but my brother has the label as autistic. I think it’s interesting because if you took one look at my brother, you would have no idea he is autistic. I think it takes a second to maybe realize that his brain works differently than mine. We are very similar but he’s the one that experiences stigma. I’m sure that is common in many people too.
Dr. Bercovici: I think one thing about diagnoses that is very limiting right now is that a lot of it is based on an external presentation. In my opinion, that’s not the best way to go because it’s not about that. It’s about your internal experiences. I share that same experience where I walk through the world and I’m very good at masking and most people won’t pick up that I’m autistic unless I have a “slip-up” you could say. But if you asked me about my internal experiences, it would be largely similar to many other autistic people. I think it’s a disservice to base our diagnoses on what it looks like externally. We forget that people can mask and camouflage and that diagnostic criteria were largely developed based on stereotypical presentations.
Gabi: I totally agree. I think when you have that external presentation of autism, the stigma and perception are way more severe than if you only considered the internal presentation. Autism is a spectrum, but I think the stigma isn’t as varied. I think the stigma is either there or it’s not there.
Dr. Bercovici: So, let me throw something else at you. Let me make this more complicated because I think you’re right. I think when someone has a very obvious stereotypical type of presentation and you are already labeled as autistic from the start, there is a lot of stigma. But, if we look at the research on who is struggling or who needs support or even who has mental health struggles, we see that undiagnosed people often have poorer mental health than those who are diagnosed. You can imagine that if you are not externally presenting as someone who needs support, you are not facing stigma, but you’re also not getting the resources you need and the self-understanding.
We actually see in the literature that this is a huge mental health concern, for example when it comes to suicide rates. It’s almost like a double-edged sword. You can’t really win. There’s discrimination in the form of stigma and judgement, and there’s discrimination in the form of not having your needs met, not having self-understanding, and not being able to live authentically.
Gabi: It’s almost like if you don’t face the stigma and you don’t experience the stereotypes it’s a good thing. But then at the same time you are not getting the support you need which is a bad thing. That’s a very interesting way to look at it.
Dr. Bercovici: Exactly. It goes back to this whole idea of invisible disabilities. You can generalize it to that category. When it’s invisible, you may not get support.
Gabi: You also mentioned that neurodiversity is an identity. I think it’s just like autism in that neurodiversity in itself is a spectrum. I think neurodiversity can present itself as a lot of things. In my opinion, I think everyone is a little bit neurodiverse which I guess isn’t the right way to put it since in literature, researchers either use neurotypical or neurodivergent rather than any term in between. I think we are all neurologically different. If you were to look inside our brains at all the neurological connections, everyone is different. Maybe neurodiverse isn’t the term to use because that isn’t how it is used in literature. But I will say I think there is something cool that we are all different neurologically. Some people are more accepting of one end of the neurodiversity spectrum. That end is more normalized compared to the other end.
Dr. Bercovici: I think the words I would use are conformity and societal norms and that’s why to me it feels like an identity because everybody has needs and everybody deserves support in different ways. But it just comes down to what is normalized by society and what society has decided are needs that are automatically met. If your needs are automatically met, then you are neurotypical. If your needs aren’t automatically met, then that means you are neurodivergent. This is a gross generalization, but that’s one angle to understand how these categorical labels within society.
Gabi: That makes sense. I realize that there is a distinction between the two.
Dr. Bercovici: Ya, and I think I generally draw that line at what is accepted by society.
How do you think academic environments can become more accommodating and affirming for neurodivergent people?
Dr. Bercovici: Big question. I think the words I gravitate toward are how we can make our environments more accessible and inclusive. Criticizing academia, I think the word accommodation refers to the idea that we will do things a certain way and for a person who needs something different, we have to compromise or do extra work or sacrifice something to accommodate that person. The burden is then placed on the individual with autism or whoever is requiring different support. I think, for me, it’s about thinking how we can make things accessible. How can we build our classrooms? How can we build our labs so that they are already inclusive, and nobody needs to make exceptions nor fight for their needs? That to me is how we become more inclusive.
Gabi: I also think it has to do with the social versus medical model of disability. I think society needs to move towards a more social model where we can put blame on what is wrong with society and what society needs to change. When you talk about the limitations of the word accommodation, I feel like it puts the burden on the individual and blames them for the support they need. It makes it seem like it’s their fault and that’s a very dangerous perspective.
For neurodivergent individuals navigating an academic or professional setting, social misunderstandings can be common. What advice would you give to people dealing with these challenges?
Dr. Bercovici: I’m a big supporter of community and finding people who you can be authentic with and can mirror your own experiences. I love the idea of having people who can translate neurotypical behavior into neurodivergent behavior and the other way around. There’s this idea called the double empathy problem. It’s the idea that it’s not just autistic people misunderstanding neurotypical people, as is the stereotype, but also recent research has shown that neurotypical people misunderstand autistic people. This challenges the long-held belief that autistic people (but not neurotypical people) lack theory of mind. It’s just that all of our research has focused on the norms of neurotypical behavior. I like this idea of translating back and forth and having someone who can act as a bridge because they understand both slides. Overall, I think that we should be approaching both sides with curiosity rather than making assumptions.
Gabi: In your opinion, do you think we, as a society, have gotten better at being curious?
Dr. Bercovici: I think so. I think research as a whole is moving in that direction. That’s definitely something I’ve seen since when I first started undergrad versus where I am now. I do see that shift. It comes down to more awareness and greater understanding. So, yes. I think we are.
Gabi: It’s very refreshing. It’s interesting because you see it through generations. Older generations have a harder time understanding but so do little kids who use the word “autistic” as a derogatory term. I think it’s a matter of also teaching neurotypical children appropriate language. It should be targeted teaching so that neurotypical children have a greater understanding.
Dr. Bercovici: What comes to mind as you are saying that is again that idea of neurodiversity as an identity rather than a diagnosis. You can say the same thing for teaching kids not to be homophobic or to not be racist. It’s the same idea. Is that what you mean?
Gabi: I think it’s more of saying to children, “let’s learn to be more accepting of others,” rather than saying, “let’s learn about autism.” I think when you say the latter you already introduce implicit biases.
Dr. Bercovici: I agree with you but a little shifted. I think my comparison with race is teaching about racism vs teaching about curiosity, not making assumptions, not being discriminatory. The comparison with autism is teaching about ableism and disability discrimination versus the curiosity about what is neurodiversity.
What are some ways you think the mental health field can become more intersectional in its approach to autism and other forms of neurodivergence?
Dr. Bercovici: My big thing is that there isn’t one definition for mental health. Mental health can look very different for different people. It’s about giving people the autonomy to define what mental health means to them. So, for autistic people, mental health might be the ability to stim in public and for them to understand that it is healthy for them. For other autistic people, they may have shame doing that and they may want to continue masking in public but come home and have strategies for releasing that energy. These differences may depend on other aspects of people’s identities like race, gender, social class, etc. It’s not for us to decide what’s healthy. I have my own opinions, but I think it’s about letting other people decide what mental health is. To expand on that, it’s also not about assuming that neurotypical mental health is optimal for everybody. We think of certain behaviors as being unhealthy, maladaptive, or distorted. That is based on the norms that neurotypical individuals express. It’s not the same for other people.
Gabi: I also think that with mental health it is different for everyone like you were saying but I think if you even just consider someone who is neurotypical, they still face mental health differently. When it comes to neurodivergence, it must have a similar approach. Mental health is not just different in neurodivergent individuals. It’s different for everyone. Resources should be accessible, not just because you are neurodivergent, but because everyone faces it differently. Just because someone has a diagnosis doesn’t mean they face mental health any differently than a neurotypical individual does.
The term “positive disintegration” is part of your therapeutic approach. Can you explain what this means and how it applies to neurodivergent individuals who are exploring or redefining their identity?
Dr. Bercovici: It’s a theory rather than a therapeutic approach. It’s a theory of personality development and is a form of how people can move towards self-actualization. People typically think of self-actualization as the top of Maslow’s Hierarchy of Needs. Positive disintegration is considered an alternate model of achieving self-actualization. It’s the idea that a lot of people experience a lot of hardships and a lot of struggles to disintegrate their personality to get closer to that. A huge part of this theory is that some individuals desperately need to be authentic and live by aligning with their values.
However, that comes at the cost of not conforming with society. This implies that there is a lot of distress and pain when moving towards self-actualization and I personally think it applies to a lot of neurodivergent people because most of us don’t conform to begin with. To give some context, the literature comes from theories of giftedness. My interpretation is a little more general. It’s a theoretical model.
Gabi: It’s almost like taking apart your identity and reorganizing it so it’s different than before. Is that what it is?
Dr. Bercovici: It’s about self-growth and this idea that you are moving towards authenticity. Personality comes into play because you can present a personality in a certain way and that might not be authentic and that might not be allowing you to reach your full potential. So, there might be a disintegration of your current personality. If you disintegrate in a “negative” way rather than “positive”, you are moving towards conformity rather than authenticity, and you wouldn’t reach your full potential. You would not move towards self-actualization.
You have experience as both a therapist and an educator. How do these roles complement each other, and what has each taught you about the other?
Dr. Bercovici: The roles feel very different to me qualitatively because as an instructor, I teach neuroscience. I teach molecular neuroscience, and neuroanatomy. We’re talking cells and neurotransmitters and all that which I know you’re familiar with. It’s funny because I usually describe to people that I live in two different worlds. I have my little academic bubble where I talk about papers and cells. Then, I have this other world where I make deep connections with people and support them. I love both. Where there is overlap is my love for theory and my curiosity. My love for being curious and understanding people complements both roles. I also love mentoring students by making space for their own unique experiences in a similar way that I make space for clients.
Gabi: Your career definitely shows a good example of the intersection between neuroscience and psychology. Neuroscience can explain a lot, especially regarding how your brain is structured. But, there are limitations to that which are explained by psychology. I think you get the best of both worlds.
Dr. Bercovici: That’s really how I felt when I moved a little bit away from neuroscience research. For my PhD, I studied executive functioning. It’s what we’re talking about because it’s related to neurodivergence, but at the time it was with animal models and pharmacological approaches and optogenetics. Although I still think about executive functioning and am still curious about it, it feels so far removed from the actual connections with people that I spend more of my time on today.
What do you have to say to girls that would like to pursue a career in STEM?
Dr. Bercovici: I think mentorship is important. I think that representation has increased, and people can now seek out mentors. I cannot stress how valuable having a mentor is. STEM is still a club meant for white men, and this comes with harmful experiences for those of us who aren’t white men. It is so easy to gaslight yourself. It’s so easy to second guess your value or feel imposter syndrome. Having a mentor is invaluable.